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Abstract: FR-PO430

Pulse Wave Velocity Is an Independent Risk Factor for Cardiovascular Events, Mortality and Decline in Renal Function in Patients with Type 1 Diabetes

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Frimodt-Moller, Marie, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Theilade, Simone, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Winther, Signe Abitz, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Tofte, Nete, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Ahluwalia, Tarunveer S., Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Rossing, Peter, Steno Diabetes Center Copenhagen, Gentofte, Denmark
Background

The prognostic significance of carotid-femoral pulse wave velocity (cfPWV), the gold standard measure of arterial stiffness, remains to be determined in patients with type 1 diabetes (T1D). We investigated the predictive value of cfPWV for development of cardiovascular events (CVE), mortality and decline in renal function in T1D.

Methods

At baseline cfPWV was measured using the SphygmoCor device in 652 patients with T1D and various degrees of albuminuria, ranging from normo- (<30 mg/24h), micro- (30-299 mg/24) to macroalbuminuria (≥300 mg/24h. Endpoints were traced through National Registers and patient records until 31st December 2016 comprising: composite CVE, mortality, progression from normo- to micro/macroalbuminuria or from micro- to macroalbuminuria, and decline in estimated glomerular filtration rate (eGFR) ≥30%. Median follow-up ranged from 5.2 to 6.2 years. Slope estimates of eGFR and urinary albumin creatinine rate (UACR) were calculated for a median of 5.5 years.
Adjustment included sex, age, mean arterial pressure, LDL cholesterol, smoking, HbA1c, UACR and eGFR at baseline. Hazard ratios (HR) were calculated per 1 standard derivation (SD) increase in cfPWV.

Results

Of the 652 participants (56% male); mean±SD age was 54±13 years, cfPWV 10.5±3.38 m/s and eGFR 81±26 ml/min/1.73m2. Median numbers of eGFR and UACR measures during follow-up were 6.0 and 17.0, respectively. After adjustment, higher cfPWV remained significantly associated with all endpoints: composite CVE (n=81; HR:1.31; p=0.045); mortality (n=48; HR:1.39; p=0.033); progression in albuminuria (n=31; HR:1.16; p=0.012); and decline in eGFR ≥ 30% (n=90; HR: 1.39; p=0.015).
Higher cfPWV was associated with a steeper decline in eGFR and a steeper increase in UACR after adjustments (p≤0.009).

Conclusion

In patients with T1D, higher arterial stiffness was consistently associated with a higher risk of CVE, mortality and decline in renal function, independent of other risk factors. Measurement of cfPWV may have a promising role in risk stratification in T1D.